Tuesday, May 30, 2006

Premium medicine in action

The thesis of Arnold Kling's Crisis of Abundance is that America's taste for "premium medicine" is the key to the rise in health-care costs. When I started reading the book, I laid out my own guesses as to the cause. One of them was a tendency to demand the latest, most expensive technology for health care. A Wall Street Journal story today ($link) shows these theories work together.

The story says that demand is so strong for the newest mammography technology, digital screening, that some patients are foregoing the old-fashioned kind even when digital is unavailable:

Interest is growing in the digital version of the breast-cancer screening test, driven in part by a study last fall in the New England Journal of Medicine that said digital was better for some women. The findings quickly became a marketing tool for makers of digital-mammography machines and hospitals that have them. Sales of the machines have been rising, with one major manufacturer citing digital equipment as the driving force behind record second-quarter revenue.

But some hospitals and doctors are concerned that the advantages of digital are being overestimated and may be causing women to delay getting a mammogram until digital machines arrive in their area. Still only about 11% of the 8,800 U.S. mammography facilities are estimated to have digital.

The story says:

The advice from doctors: Don't wait, especially if you are in one of the groups for whom digital has no demonstrated advantages. The study found that digital was better at detecting cancer only for premenopausal women, those under 50 years old, or those who have dense breasts. The majority of women who get mammograms are over 50, and looking at the 40,000 women in the study as a whole, the new technology was found to be no better than film overall.

Crisis of Abundance says
"An important characteristic of premium medicine is that many procedures have a low probability of affecting the outcome. In fact, often the procedures do not even affect the treatment plan."

Digital mammography seems an apt illustration of this point. It is more effective for only a minority of patients, and the treatment for a cancer discovered digitally doesn't differ from that discovered on film. Yet as it is the latest technology, and in short supply, the digital technology will cost more. It's an illustration of "premium medicine" that could have come right out of C of A. And, as C of A notes, spending on imaging services is growing twice as fast as health spending as a whole.

Maybe somebody will disprove the premium medicine explanation for high health costs, but it sure seems to me to explain a lot.

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